Organization
NORTHWEST CHILDREN'S HOME
Active
Other names
Community Based Counseling, Residential Facility
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNY SKEELS (BUSINESS OFFICE MANGER)
(208) 743-9404
Entity
Organization
Contact information
Practice address
419 22ND AVE, LEWISTON, ID 83501-3812
(208) 743-9404
Mailing address
419 22ND AVE, LEWISTON, ID 83501-3812
(208) 743-9404
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LCPC-2754
ID
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002265000
—
ID
05
—
804258900
—
ID
05
—
807371000
—
ID
05
—
807385500
—
ID
05
—
807385700
—
ID
Enumeration date
03/01/2007
Last updated
02/06/2020
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